The Irish standard., 1887-03-26
A CRITICAL OPERATION.
Strange Case of Phosphorus Poisoning
in q New York City HOSPITAL.

y
tient in the Charity Hospital on Blackwells
Island writes New York Correspondent.
When he was first admitted to the hos
pital, a few months ago, his legs and body
were covered with Strengthening spots,
which in some places had progressed into
an ulcerOus formation. 1t had been sup
posed by a physician, who had been treat
ing the case, that the disease was leprosy
AS this disease is never met with here
reliance had to be placed upon the pub
lished description of the symptoms, and
there We're many OF the characteristics.
The diagnosis We're believed to stand on
fairly sound basis as there was no history
Of syphilitic complication. The patient
was put under treatment in an isolated
ward in the hospital and closely watched.
There was no change for the better, and
the effect OF medicine Of any kind was ag-
gravating to the symptoms The ulcers
and spots had been upon the body for
about two years. The mouth and neck OF
the patient were greatly swollen, but the
real cause Of this was not discovered at
first, as the condition was thought to be a
manifestation Of the disease. There were
no teeth in the lower jaw The patient
said that they got so loose that
it was no trouble to pull them out with his
fingers. A portion OF the teeth on the
upper jaw were also out. but these had not
dropped out like the teeth on the lower
jaw. The patients breath was SO foul
that it made his own life a burden, and the
stomachs Of his attendants were rarely in
good working order. the lower lip being
depressed, the symphists Of the inferior
maxilary could be seen. It was entirely
necrosed and in a horrible condition.
Phosphorus, it is claimed, will cause
necrosis Of the bone. This patient
worked for several years in a match tao
tory, and the first trouble that he had with
his jaw was While there. His teeth had
never been good, and the PHOSPHORUS had
an excellent chance to demonstrate what
it could do in the way OF necrosis There
had never been any bodily sores until aft
er the trouble with the jaw began.
A careful examination showed that the
disease had involved the entire lower jaw
and extended to the right articulation
There is only one remedy for necrosis and
that is the extirpatiou of the bone. But
the system of the patient was in such
condition that it made it Ii dangerous COM
plicaton, and difficult to determine what
the effect of the operation would be.
However, as the patient was gradually
getting weaker. and the question of
fatal termination WAS only a matter OF
tirae, and short at that, it relief was not
given, it was decided to operate.
The patient was placed under the influ-
ence OF ether, in the large Amphitheater of
the hospital, in the presence of large
number of students and physicians. An
incision was made from the point Of the
chin to the lower lip, the red portion not
being touched. From the point Of the jaw
the incision was extended TO the right,
10
protuberance under the ear. A similar in
cision was made on the right side. Then
the cheeks on both sides OF the face We're
dissected from the bone and the looseneG
flesh was turned up over the face. This
exposed the bone in all its hideousness
Forceps were applied to the bone at it's
middle portion and even under a light
pressure it crumbled The odor given out
was almost unbearable. AS the bone
would break away a new hold was TAKEN
until it had been removed up to the limit
of the incision. To get at all the diseased
bone the cheek had to be cut again, the
knife being run through tine tissue in front
of the ear.
The right articulation was removed with
but little trouble, as it was badly affected.
The attachment of the bone at the left
articulation was firm. Several tendons
had to be cut, during which proceeding the
maxillary artery was punctured. The
blood spurted inuo the. throat, and before
pressure could be put on the artery the
crimson fluid entered the urachea. The
patient was in danger of suffoca-
ton. The operating surgeon turned
the head of the patient downward, forced
his hand into the throat, and absorbed the
blood with sponge. 1t required Il large
tof cti " MI
ly, to bring the patient to a condition. where
it was deemed safe to go on with the work.
AS the muscular attachment was divided,
the tongue dropped back into the throat
To prevent the closing of the CLOTHS.
threaded needle was run through the tip
of the tongue, and it was drawn out and
held by an assistant. The lacerated artery
hae9ng been tied, the tendon holding the
bone in position was severed, and by ro-
tating the bone with forceps the articula-
ton was broken and the bone removed.
All the tissue in the neighborhood Of the
bone that had been affected was cut away,
and the wound was thoroughly washed.
&, Then began the delicate task of putting
back the flap and fastening it in position
a large acupressure pin was introduced
near the sub maxillary glands into the in
tegumcnt by which the severed muscles
were pinned TO the neck Inc WOund
was frightful looking affair, and
was closed with interrupted sutures.
The union of the vermilllon lip by
sutures was made with great skill, and it
is q very difficult thing to do so as not to
draw the lip out of shape. The wound was
bandaged and the patient put to bed in
two hours after the other was given. Care
full attention was given to the subsequent
dressing, and any sloughing that appeared
was Immediately cut away. The pins were
removed in seven days, and the muscles
were joined almost as we'll as if they never
had been cut
The wound healed slowly. and there was
a persistent flow Of pus. At the end OF a
month the flesh hung naturally from the
upper lip and in such manner as to give
the face a constant smile. The marked
feature of the case is that the spots and
ulcers on the body healed and passed away
as the wound in the mouth became better,
and at the end of three months there were
no marks on the body and only few small
ulcers on the legs, that are gradually dimin-
fishing and will soon disappear. The pa
TENTS health is good. A cartilage is form
ing in the mouth in place of the jaw, and is
already quite firm, and the Disagreement
is 80 slight as not to be noticeable unless
the head is upturned and the scar on the